this is hysterical. reminds me somewhat of what happens when you try to bill Medicare part b for diabetic supplies for a patient with a m'care advantage plan. B, who normally covers, says bill the advantage plan, advantage plan says no supplies covered. also Patient has secondary insurance but that only covers benzo and OTC. you can't be diabetic with an advantage plan

It's really not so hilarious when you're 6 grand in the hole for an ER admit for observation because your kid was sick and private insurance just dropped him because he met his deductible this year. Yeah. Capitalism all the way; we don't just 'seize the day', but we seize the sucka, sock it to 'em, suck it all outa him.

This is an average Joe. Not someone waiting in line at the free clinic, just because we chose the wrong career path in college. Nope. Someone that unfortunately actually got sick and had to use the insurance.

I'm with Annonymous. Throughout the last year or so as I was diagnosed with and than began treatment for depression I saw my doc and a few psychologists. I considered myself very lucky because as a student I was to access support many can't. By why can't his GP or internist make the diagnosis?

And for this same reason my husband's GBM tumor was over 8cm when it was finally taken from his head some 9 months after it started growing. With an MRI when his symptoms first started who knows how many more years we could have had?

Many people misunderstand who pays for health insurance. It is convenient to think that "good" employers provide health insurance, but "mean and stingy" employers leave their employees to scrounge for themselves. They complain that everything would be fine if we forced all employers to be "good".

In reality, an employee's health insurance and all other benefits are part of his earnings, part of the payment he gets for doing his job. The tax law encourages an employee to receive some of his earnings in tax-free health insurance outside of his paystub, with all other earnings reported on his paystub. It is all payment to the employee, from the view of the employer.

People are already personally paying for their "employer-paid" insurance. They don't buy it directly so (1) it doesn't attach to them when they change jobs, (2) and they can't shop for the insurance they might want. The employer writes the check with part of the money earned by the employee.

The worst part is that people like the above patient get insurance purchased by his employer, and all of the "gotchas" are there to lower the employer's cost. The employer may feel that he is doing the best he can, given the economic balance between offering more cash or more insurance.

Untangle the tax mess, remove employers from the middle, and salaries would go up in the amount of the "free" healthcare benefit through employers. Then most people would have enough take-home pay to buy their own health insurance. Doctor's and insurance companies would compete for their business, pressing prices down. That is what healthcare reform should be about, along with removing anti-competitive rules and interest group mandates from the insurance market.

When I was having my migraine work up last spring, we wanted a head CT to rule out sinus causes (because I have a history of them), and they wouldn't let my GP order it, it had to be the ENT. So they paid extra for another two appointments with ENT so I could get the MRI (which they happily OKd from ENT). Not surprisingly, it was clear, so wouldn't it have saved everybody, including Aetna, money to let the GP order the test, and then send me to ENT if it had looked funny?Same with the echo, since I have a clotting factor disorder and an arrhythmia - only cardiology can order that test, so that was another two visits to a specialist. Again, if they'd allowed my Neuro to order the test, if it had come back with issues I could have then gone to Cardio. So all told I count four unnecessary specialist visits paid for by Aetna because of their own stupid rules. I don't think it saved them any money.

That is ludicrous! I don't see how medical authorizations people can go to work everyday to spew out authorization guideline nonsense like that! Granted, we have our share of MD offices that despise us based on certain med guidelines we have in place but we suggest alternatives that are covered.....Hmmmm

Yep. Another day in the life of a pt with a difficult-to-treat illness. And another day for her/his doc.

As someone with a newly dx condition, it is typical of what I am getting. Went for s stress test after a weekend in the hp with chest pain and funny cardiac enzymes. (no infarct) Turns out the nice lady at the admit desk said I had BC from the state I live in.

WRONG

I have BCBS from another state. One that requires pre-auth for the stress test.

Of course, this is not figured out until I've gone to the office after a 12-hour fast. So nice lady at cardiologists' calls and calls this version of BCBS until she gets a HUMAN not the computer.

I got the test. And the results are "abnormal." I love American medicine, but ...

Sorry, Mr. Garland but most companies today use a company sponsored insurance plan. That means a billing agent (like Blue Cross) estimates the cost of each plan per person and family and the company offers a percentage of the premium and the employees pick up the tab for the rest. Blue Cross isn't paying the tab for the bills, however. The Company is actually paying the bills, offset by the amount of the premiums. Blue Cross is only the billing agent, do all the handling. The actual dollars for everything are coming from said employees and Company.

If you are in plan like this, a Company sponsored plan, you can try to work with the Company to get changes made. However, if you are one causing big bills to be run up, that can be dangerous. It is against the law for you to lose your job because of health issues but we all know that it can and does happen.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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